Enhanced Recovery After Surgery Pathways and Their Influence on Postoperative Recovery, Length of Stay, and Complications: A Comparative Cohort Analysis

Abstract

Enhanced Recovery After Surgery (ERAS) protocols represent a comprehensive, evidence-based approach to perioperative care that integrates multiple interventions aimed at minimizing surgical stress, promoting early recovery, and improving overall patient outcomes. This comparative cohort study evaluated postoperative recovery profiles among 180 adult patients undergoing major surgical procedures, with 90 patients managed using an ERAS protocol and 90 receiving conventional perioperative care. Recovery outcomes were assessed through key clinical milestones, including time to initiation of oral intake, ambulation, return of bowel function, length of hospital stay, postoperative complications, and hospital readmission rates. Statistical analyses were performed using independent t-tests and chi-square tests, with multivariable adjustment to account for baseline demographic and clinical differences between groups. Patients managed under the ERAS pathway demonstrated significantly improved recovery profiles compared with those receiving conventional care. Early initiation of oral feeding, faster mobilization, and quicker restoration of bowel function were consistently observed in the ERAS group, reflecting enhanced physiological recovery following surgery. Furthermore, the average length of hospital stay was significantly reduced in patients treated with the ERAS protocol (4.2 days versus 6.5 days; p < 0.001), indicating more efficient postoperative recovery and resource utilization. The incidence of postoperative complications was also lower among ERAS patients, suggesting that coordinated perioperative interventions contribute to improved surgical outcomes and reduced morbidity. Importantly, these benefits were achieved without an increase in hospital readmissions, demonstrating that earlier discharge did not compromise patient safety or quality of care. The findings support the growing body of evidence that ERAS programs enhance recovery, reduce complications, and optimize healthcare utilization. Routine implementation of ERAS protocols may therefore represent an effective strategy for improving perioperative outcomes and promoting patient-centered surgical care across a wide range of major surgical procedures.